Skip to main content
College of Midwives Ontario logo

Standards Review: Important changes in effect as of June 1, 2021

June 3, 2021

At its December meeting, Council made a number of important decisions regarding College standards of practice that came into effect on June 1, 2021.

These changes follow two rounds of consultations with midwives, including a 9-week public consultation held last year during which midwives, the public and a wide range of stakeholders took the opportunity to provide feedback on our proposals.

The following changes were approved.

  1. The following standards of practice has been rescinded
    • Consultation and Transfer of Care Standard (CTCS)
    • When a Client Chooses Care Outside Midwifery Standards of Practice
    • Delegation, Orders and Directives
  2. The following document was implemented
    • The Midwifery Scope of Practice describes the legislative scope of practice and will replace the CTCS.
  3. The following standards and guiding documents was amended
    • The Professional Standards for Midwives to:
      • set minimum expectations for midwives after a transfer of care (standard #26)
      • include additional standards on delegation (standard #31) and to revise the definition of “delegation” in the Glossary of Terms
    • The Guideline on Ending the Midwife Client Relationship to provide guidance to midwives in situations when a client chooses care that falls below a standard of the profession.

See the revised documents.

Why did the College make these changes?

In 2016, we adopted a principles-based approach for developing the standards of practice; an approach that relies on broad principles, rather than rigid rules that midwives must follow. Adopting this approach required a review of all of the College’s existing standards in two discrete phases. The first phase of the standards review involved developing and implementing the Professional Standards for Midwives and rescinding 25 of the College’s existing standards on June 1, 2018. The second phase of the standards review involved developing a document describing the midwifery scope of practice so the CTCS could be rescinded, and revising the Professional Standards for Midwives and the Guideline on Ending the Midwife Client Relationship to allow for the rescinding of the standards When a Client Chooses Care Outside Midwifery Standards of Practice and Delegation, Orders and Directives. For more information about our rationale for making these changes, see the consultation paper.

What have midwives said about these changes?

In May 2019, we consulted with midwives about the CTCS. This consultation found overall support for rescinding the document and replacing it with a document describing the legislative scope of midwifery practice. The findings from the consultation can be found in the consultation paper (see pp. 4-6).

Between August and October 2020, we launched a second consultation about the proposed changes. Twenty-seven responses were received of which twenty-three were from midwives or midwifery students, three were submitted on behalf of midwifery practice groups, and a letter was submitted by the Association of Ontario Midwives (AOM).

Responses were mostly supportive of the overall approach to rescinding the CTCS and implementing a guiding document on the scope of practice. Some respondents felt that rescinding the CTCS and implementing the new Midwifery Scope of Practice will increase the autonomy of midwives, support interprofessional collaboration and put client safety first. Some respondents felt the opposite expressing concern that rescinding the CTCS will erode the scope of practice and create more tension with interprofessional colleagues.

All of the responses were taken into consideration and led to a number of important changes that were reviewed by the Quality Assurance Committee (QAC) in November 2020 and accepted by Council in December 2020. Changes from two reviews by the AOM were also incorporated.

The findings from the consultation, including our response to the second round of consultation can in the consultation paper.

What does this mean for my practice?

Rescinding the CTCS will change your practice because specific indications for consultation and transfer of care will no longer be set out in a College standard. Instead, as primary care providers, midwives will be expected to consult and transfer care based on the legislative scope of practice set out in the Midwifery Act, 1991 and their individual competence and professional judgment. The Midwifery Scope of Practice was developed specifically to provide regulatory guidance to midwives about working within the midwifery scope of practice and what to do when a client’s clinical condition or the care they require is no longer in the midwifery scope. We also developed decision-making tools to assist midwives in determining which clients and what activities are in the midwifery scope of practice and when to transfer care or to accept a delegation. Practices may develop consultation and transfer of care protocols taking into consideration their practice setting, community standards as well as their client base.

Rescinding the standard Delegation, Orders and Directives will not change your practice. The term has been more clearly defined and additional standards have been added to the Professional Standards for Midwives.

Rescinding When a Client Chooses Care Outside Midwifery Standards of Practice will not change your practice. The requirements set out in the standard are now included in the Guideline on Ending the Midwife Client Relationship.

How can I find out more about these changes?

We held two webinars this past spring to answer any outstanding questions midwives had about the legislative scope of practice. If you were not able to join one of the webinars, we are always happy to answer questions by phone and by email. You can contact us for practice advice at practiceadvice@cmo.on.ca

Related links

Downloadable documents

Standards Review Timeline

Infographic of the Standards Review Process sharing this information:

2015:
Review of the standards to bring them in line with current evidence in regulation and governance of health practitioners
2016:
Council accepts the standards review report and approves the overall direction..
The College presents its new approach to regulation to the AOM & MEP faculty.
2017:
Council holds two rounds of public consultation on the Professional Standards.
College holds Member Education Day and continues to consult with members, students and stakeholders. 
2018: 
The finalized Professional Standards are approved by Council
Professional Standards come into force and 23 standards are rescinded. 
2019:
The College consults with midwives about using the CTCS in practice. Responses highlight its prescriptive nature and the limits it puts on clinical judgment. 
2020:
Consultation with midwives about the Midwifery Scope of Practice and rescinding three standards including the CTCS. 
Responses were overall supportive of the overall approach 
Council approves implementation of these changes to take effect June 1, 2021.
2021: 
May: College holds two webinars to answer questions about these changes
June 1: Implementation of the Midwifery Scope of Practice and rescinding the CTCS, When a Client Chooses Care Outside Midwifery Standard and Delegation, Orders and Directives

Tags: , , , , , , , , ,